HomeMy WebLinkAbout0053 ALPINE WAY - Health 53 .Alpine Way
Marstons Mills /
A= 081 - 021
No. . OZD7 o�Us Fee S
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓y�
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ,Yes
0[pprication for �Digooal *p6tem Con6truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) (Ba�,done Complete System ❑Individual Components
Location Address or Lo No. 144 / '( Own ame,Address,and Tel.No. f
filpi.✓� 4t;% S -.9!a/
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
i9 l ,S f
5',0f -2 >s'
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to lace the system in operation until a Certificate of
Compliance has been issued by this of Health.
Sign Date
Application Approved by — Date
Application Disapproved by: Date
for the following reasons
Permit No. ;0 07— 0.5 Date Issued fJ `i8_c)7
No. . 2-007 " �y� dZ S_ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpplication for fist ossal 6p5tem (Construction Permit
Application for a Permit to Construct O Repair O Upgrade( ) Abandon O ❑ Complete System ❑Individual Components
k J
Location Address or Lo No. 14 ,114 Owner's-Nam Address,and Tel.No.
� fi+;A,E �r
Assessor's Map/Parcel. 67 2/ U.2
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
A2Gr-/ r A�' S f
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when appliiccaLble)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this
BsQa5da of Health. _.
Signed% Date 5 / �
Application Approved by 4 Date
Application Disapproved by: Date
for the following reasons
j
Permit No. 9-0 07— .2 0 5 Date Issued r7 _ �g-d 7
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned-(— )byP f1 C /'7,
at S73 has been constructed in accordance '
with the provisions of Title 5 and the for Disposal System Construction Permit No. `}-U 0 7 r 2 05 dated S'/ V-07
Installer //�� Designer
#bedrooms A Bie Y✓ /e Approved eTtg flow gpd
The issuance of this ermi shall not be construed as a guarantee that the systeZwill f�tio as designe nn
Date 1��� Inspector ��q (C
No. 12 UO7";Z US Z
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
xl gpOg�Y 6pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ellY
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions. Sw
Provided: Construction must be completed within three years of the date of this permit. �4
Date �j A'�7 Approved by U--1